A systematic review of online interventions for mental health in low and middle income countries: a neglected field.

BACKGROUND: Low and middle income countries (LMICs) are facing an increase of the impact of mental health problems while confronted with limited resources and limited access to mental health care, known as the 'mental health gap'. One strategy to reduce the mental health gap would be to utilize the internet to provide more widely-distributed and low cost mental health care. We undertook this systematic review to investigate the effectiveness and efficacy of online interventions in LMICs. METHODS: We systematically searched the data-bases PubMed, PsycINFO, JMIR, and additional sources. MeSH terms, Thesaurus, and free text keywords were used. We included all randomized controlled trials (RCTs) of online interventions in LMICs. RESULTS: We found only three articles reported results of RCTs on online interventions for mental health conditions in LMICs, but none of these interventions was compared with an active control condition. Also, the mental health conditions were diverse across the three studies. CONCLUSIONS: There is a dearth of studies examining the effect of online interventions in LMICs, so we cannot draw a firm conclusion on its effectiveness. However, given the effectiveness of online interventions in high income countries and sharp increase of internet access in LMICs, online interventions may offer a potential to help reduce the 'mental health gap'. More studies are urgently needed in LMICs.

The methods and outcomes of cultural adaptations of psychological treatments for depressive disorders: a systematic review.

BACKGROUND: Cultural adaptations of evidence-based psychological treatments (PTs) are important to enhance their universal applicability. The aim of this study was to review systematically the literature on adaptations of PTs for depressive disorders for ethnic minorities in Western countries and for any population in non-Western countries to describe the process, extent and nature of the adaptations and the effectiveness of the adapted treatments. METHOD: Controlled trials were identified using database searches, key informants, previous reviews and reference lists. Data on the process and details of the adaptations were analyzed using qualitative methods and meta-analysis was used to assess treatment effectiveness. RESULTS: Twenty studies were included in this review, of which 16 were included in the meta-analysis. The process of adaptation was reported in two-thirds of the studies. Most adaptations were found in the dimensions of language, context and therapist delivering the treatment. The meta-analysis revealed a statistically significant benefit in favor of the adapted treatment [standardized mean difference (SMD) -0.72, 95% confidence interval (CI) -0.94 to -0.49]. CONCLUSIONS: Cultural adaptations of PTs follow a systematic procedure and lead primarily to adaptations in the implementation of the treatments rather than their content. Such PTs are effective in the treatment of depressive disorders in populations other than those for whom they were originally developed.

Dental implants in growing children.

The replacement of teeth by implants is usually restricted to patients with completed craniofacial growth. The aim of this literature review is to discuss the use of dental implants in normal growing patients and in patients with ectodermal dysplasia and the influence of maxillary and mandibular skeletal and dental growth on the stability of those implants. It is recommended that while deciding the optimal individual time point of implant insertion, the status of skeletal growth, the degree of hypodontia, and extension of related psychological stress should be taken into account, in addition to the status of existing dentition and dental compliance of a pediatric patient.

Re-osseointegration of loosened implant in a splinted fixed prosthesis.

Various studies have proved the success of the osseointegration concept, if proper and strict protocols are followed for the success. In clinical practice, certain situations arise that makes the clinician to modify his treatment modality to favor the final outcome of the treatment. This paper presents a clinical case report of re-osseointegration of the loosened bead implant occurred during the torque application to tighten the abutment during cementation, which was splinting along with the adjacent well-osseoingrated implant by using fixed partial denture prosthesis. The clinical outcome suggests that proper stabilisation of a loosened implant can re-osseointegrate the implant.

Dentin comparison in primary and permanent molars under transmitted and polarised light microscopy: an in vitro study.

UNLABELLED: Dentin is the fundamental substrate of restorative dentistry and its properties and characteristics are key determinants of nearly all restorative, preventive and disease processes of the teeth. The intrinsic permeability of dentin is responsible for permitting bacterial or chemical substances to diffuse across the dentin and irritate the pulpal and periradicular tissues. Improved understanding of the dentin structure and nature will have important consequences for today's dental procedures. The aims of the study were to observe the direction of dentinal tubules, interglobular dentin, incremental lines of dentin and the dead tracts. MATERIALS AND METHODS: A total of 30 teeth (15 primary and 15 permanent molars), unrestored, noncarious, hypoplastic extracted molars were used. Longitudinal ground sections of teeth were obtained using hard tissue microtome. RESULTS: Examination of ground sections of the primary teeth dentin showed "s"-shaped curvature in four (26.7%) specimens and a straight course of dentinal tubules in 11 (73.3%) specimens out of 15 teeth examined whereas in permanent teeth, all 15 (100%) specimens showed an "s"-shaped curvature. These results are statistically highly significant (P < 0.001). CONCLUSION: Dentinal tubules followed an "s"-shaped course in all the 15 (100%) permanent molars and in four (26.7%) primary molars. There was no significant difference in the occurrence of interglobular dentin of primary and permanent molars. But, they were at angles in the primary teeth.

The effect of spousal violence on women's health: findings from the Stree Arogya Shodh in Goa, India.

BACKGROUND: Spousal violence has wide-ranging effects on the physical, reproductive, sexual and psychological health of women. There are few longitudinal studies that describe this association in developing countries. AIM: To test the hypothesis that spousal violence is an independent risk factor for a broad range of adverse health outcomes in women. SETTING AND DESIGN: A population-based cohort study of women living in the catchment area of a primary health center in north Goa. Two thousand four hundred and ninety-four of 3000 randomly selected women were recruited of whom 1750 married women were included for this paper. MATERIALS AND METHODS: Each participant was assessed at baseline with a structured interview for the assessment of exposure to spousal violence (verbal, physical, sexual) over two time periods (lifetime; recent in the past three months). The interview collected data on gynecological complaints and the Revised Clinical Interview Schedule was used for the diagnosis of depressive disorder. Laboratory tests for anemia and sexually transmitted infections (STI) were carried out. Longitudinal data was collected after six and 12 months on these outcomes. In addition, baseline measures for nutritional status and menstrual health were also obtained. STATISTICAL ANALYSIS: Univariate analyses were carried out on the cross-sectional and longitudinal data to assess the association between each type of spousal violence and each health outcome. Multivariate analyses adjusted for age, literacy, household per capita income. Logistic regression was used for all analyses in Stata (Version 10). RESULTS: Lifetime spousal violence was reported by 290 (16.6%, 95%CI=14.9-18.4) women; recent violence was reported by 230 (13.0%, 95%CI=11.6-14.8). The cross-sectional data showed an association between violence and a range of self-reported gynecological complaints, low Body Mass Index, depressive disorder and attempted suicide. The longitudinal analyses confirmed these associations only for STI and attempted suicide. CONCLUSION: Spousal violence is specifically associated as an independent risk factor for two adverse women's health outcomes, viz., STI and attempted suicide. Public health and clinical programs targeting these outcomes must specifically address spousal violence.

Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires.

BACKGROUND: Screening of patients for common mental disorders (CMDs) is needed in primary-care management programmes. This study aimed to compare the screening properties of five widely used questionnaires. METHOD: Adult attenders in five primary-care settings in India were recruited through systematic sampling. Four questionnaires were administered, in pairs, in random order to participants: the General Health Questionnaire (GHQ, 12 items); the Primary Health Questionnaire (PHQ, nine items); the Kessler Psychological Distress Scale (K10, 10 items), and from which we could extract the score of the shorter 6-item K6; and the Self-Reporting Questionnaire (SRQ, 20 items). All participants were interviewed with a structured lay diagnostic interview, the Revised Clinical Interview Schedule (CIS-R). RESULTS: Complete data were available for 598 participants (participation rate 99.3%). All five questionnaires showed moderate to high discriminating ability; the GHQ and SRQ showed the best results. All five showed moderate to high degrees of correlation with one another, the poorest being between the two shortest questionnaires, K6 and PHQ. All five had relatively good internal consistency. However, the positive predictive value (PPV) of the questionnaires compared with the diagnostic interview ranged from 51% to 77% at the optimal cut-off scores. CONCLUSIONS: There is little difference in the ability of these questionnaires to identify cases accurately, but none showed high PPVs without a considerable compromise on sensitivity. Hence, the choice of an optimum cut-off score that yields the best balance between sensitivity and PPV may need to be tailored to individual settings, with a higher cut-off being recommended in resource-limited primary-care settings.

Does nasal breathing cause frictional trauma in allergic rhinitis?

OBJECTIVES: Frictional stress on the walls of a tube increases with increased air flow and as the diameter of the tube is reduced. High values of frictional stress may occur in the nose during nasal obstruction which could damage the nasal mucosa particularly when the mucosa is inflamed and fragile as in allergic rhinitis. The effect of nasal airflow induced frictional stress on the nasal mucosa was studied in patients with allergic rhinitis. METHODS: We studied nasal peak flow rate in eight patients with allergic rhinitis and nasal obstruction comparing the change in peak expiratory flow after they breathed for 30 minutes through an obstructed and a patent nostril. Patients were studied in the right and left lateral decubitus positions to increase and decrease the resistance in the lower and upper nostril respectively and thus minimize any effects of cyclical changes in nasal resistance. Subjects breathed for 30 minutes through the upper patent nostril (schedule 1) and for a further 30 minutes through the lower obstructed nostril (schedule 2). Nasal peak expiratory flow rate was measured in both nostrils separately in both positions after each schedule. RESULTS: There was a significant reduction in mean (SD) nasal peak flow rate (-12.8 (4.06) L/min) after subjects had breathed for 30 minutes through the obstructed nostril. There was no significant change in nasal peak flow rate after subjects had breathed through the patent nostril, or in the nostril that had no flow for 30 minutes. CONCLUSIONS: These findings are compatible with the hypothesis that frictional stress due to airflow through an obstructed nostril induces trauma and swelling of the nasal mucosa of patients with allergic rhinitis.

The role of cough and hyperventilation in perpetuating airway inflammation in asthma.

Air flowing through a pipe exerts frictional stress on the walls of the pipe. Frictional stress of more than 40 N/m2 (velocity equivalent of air 113 m/s) is known to cause acute endothelial damage in blood vessels. The frictional stress in airways during coughing may be much greater, however, since the velocity of air may be as high as speed of sound in air. We suggest that high levels of frictional stress perpetuate airway inflammation in airways which are already inflamed and vulnerable to frictional stress-induced trauma in patients with asthma. Activities associated with rapid ventilation and higher frictional stress (e.g. exercise, hyperventilation, coughing, sneezing and laughing) cause asthma to worsen whilst activities that reduce frictional stress (Yoga 'Pranayama', breathing a helium-oxygen mixture and nasal continuous positive airway pressure) are beneficial. Therefore control of cough may have anti-inflammatory benefits in patients with asthma.

Marketing healthcare: lessons for smaller hospitals.

Recently, I have noted ubiquitous trends that lead me to conclude that we are on the brink of a fundamental change in the structure of healthcare delivery. Hospitals are changing. The hospital, that enduring and pervasive organization, which for decades has delivered the vast majority of acute care services is being re-conceptualized. Administrators and executives in today's hospitals are beginning to recognize the disaffection of constituents and the necessity to change from placing their own agenda or that of their profession over the needs of the customer. A lesson that is increasingly being heeded, particularly by the leading hospitals, is that a belief in one's own importance or a feeling of invulnerability represents an anachronistic stance. No hospital today can afford to retain a view that it is more important than the patients it serves, or that it is invulnerable. The external pressures are already clear--the actors, factors and forces in the external environment are forcing hospitals to re-evaluate efficiency, effectiveness and delivery arrangements. The rise to prominence of the outcomes movement is part of this trend. The present study was an attempt to assess the practices and trends in the modern smaller hospitals as a part of their strategy to match the competitive pressures.

Variation at the MJD locus in the major psychoses.

Expansion of triplet repeats has been seen to underlie several disorders that manifest anticipation. Clinical evidence suggests that anticipation occurs in the major psychoses. We studied the distribution of repeat sizes at the Machado-Joseph disease (MJD) locus in a group of patients with the major psychoses. We did not find any large expansions, though 2 patients had alleles that were two repeats larger than in our controls. The difference in allele sizes was larger in the patient sample as compared to the controls. The effect of such large differences might be of functional significance.

Telephone mouthpiece as a possible source of hospital infection.

A bacterial culture from telephone mouthpiece showed that 47 percent of the instruments carried pathogenic bacteria. Wiping with a disinfectant swab reduced the number of contaminated telephones. But for complete elimination of bacterial contamination changes in design of mouthpiece holes or type of instrument or using a polythene plastic cover over mouthpiece is recommended.